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Dr. James Fries recently passed away. His pioneering and seminal work showed that the major benefit of a healthy lifestyle was not so much increased quantity of life, but increased quality of life by forestalling chronic disease and disability.
He was a philosophy major at Stanford and pursued his medical degree and residency at Johns Hopkins where he remained as a faculty member in the rheumatology department. He was the author of several books, one of which sold more than 15 million copies.
Dr. Fries observed that the key 20th century public health advances–vaccination and sanitation– were vital to increasing life expectancy, but failed to improve one’s “health span,” the number of years free from chronic conditions such as diabetes, cardiac disease, cancer, etc.
On the other hand, Dr. Fries observed that a healthy lifestyle—a nutritious diet, maintaining a normal weight, regular exercise, and staying away from tobacco (as opposed to a poor diet, carrying excess weight, sedentary living, and using tobacco) — increased longevity, but its major salutary effect was the reduction of morbidity (affliction with chronic disease and disability). In other words, while a healthy lifestyle will help you live longer, its real benefit is in postponing and compressing the onset of debilitating disease that is virtually inevitable at the end of life. He first published this concept of “morbidity compression” in a 1980 article from the New England Journal of Medicine.
“Anguish arising from the inescapability of personal choice and the ability to avoid personal consequences may become a problem for many. For others, exhilaration may come from recognizing that the goal of a vigorous long life may be an attainable one.”
James Fries, MD
No matter what one’s state of health is, at some point things will inevitably go south. Although there are many exceptions, one’s end-of-life course is typically marked by a slowly progressive functional deterioration. Frailty, weight loss, sensory impairment (visual, auditory, etc.), and possible cognitive changes may occur. The potential for falls and bone fracture (particularly hip fracture) increase substantially. If this occurs, it may initiate a vicious cycle of escalating and cascading health issues including the possibilities of hospitalization, deep venous thrombosis (blood clotting), pneumonia, urinary infection, sepsis, and multi-system organ failure that not uncommonly ultimately results in death. To paraphrase one of my medical school professors, “We enter the world under the brim of the pelvis and exit through the neck of the femur.”
Not only will maintaining a healthy lifestyle forestall the time to one’s health breaking bad, but when it does so, it will abbreviate the morbidity that occurs before ultimately succumbing.
Bottom Line: Chronic diseases often occur because of poor personal lifestyle choices. A healthy lifestyle, more so than promoting longevity, will optimize one’s health span and minimize and compress the morbidity that most often precedes mortality.
The information on Dr. Fries was sourced from a NY Times article by Clay Risen.
